| NPI | 1750370839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 2938) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 2938) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2019-02-11 |